Monday, October 3, 2022

When Was Pneumonia Vaccine Invented

Vaccines For Adults Increasing Opportunities For Health

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Historically, vaccines were deemed to be only for children. However, vaccines for adults are becoming increasingly common and necessary. Most adults think only of the tetanus booster recommended every 10 years and even then, many adults only get the vaccine if they injure themselves. In 2005, the Tdap vaccine was licensed as an improved version of the typical tetanus booster, Td. The newer version also contains a component to protect against pertussis . All adults, especially those who are going to be around young infants, should get the Tdap vaccine. Adults often unwittingly pass pertussis to young infants for whom the disease can be fatal. In 2012, the CDC recommended that pregnant women get a dose of Tdap during each pregnancy between 27 and 36 weeks gestation. In 2019, the CDC recommended that Tdap or Td vaccine could be used for booster dosing every 10 years.

Influenza vaccines, available since the 1940s, are now recommended for most adults. Vaccines like MMR and chickenpox are recommended for adults who have not had the diseases, and vaccines including hepatitis A, hepatitis B, pneumococcus, and meningococcus are recommended for sub-groups of the adult population. The HPV vaccine became available in 2006. In 2018, the license was expanded to include people up to 45 years of age.

The first formal adult immunization schedule was published in 2002 and is updated annually.

Persons With Chronic Diseases

Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional information about vaccination of people with chronic diseases.

Asplenia or hyposplenia

Hyposplenic or asplenic individuals should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine, followed by a booster dose of Pneu-P-23 vaccine. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.

Chronic kidney disease and patients on dialysis

Individuals with chronic kidney disease should receive age appropriate pneumococcal vaccines. Children less than 18 years of age with chronic kidney failure or nephrotic syndrome, should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine. Adults with chronic kidney failure should receive Pneu-P-23 vaccine. Adults with nephrotic syndrome should receive Pneu-C-13 and Pneu-P-23 vaccine. Due to the decreased immunogenicity and efficacy of Pneu-P-23 vaccine in children and adults with chronic kidney failure, 1 booster dose of Pneu-P-23 vaccine is recommended. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.

Neurologic disorders

Chronic lung disease, including asthma

Chronic heart disease

Chronic liver disease

Endocrine and metabolic diseases

Non-malignant hematologic disorders

Cochlear implants

Serum Institute Conducted A Three

The Drug Controller General of India has given its nod of approval for India’s first indigenously developed vaccine against pneumonia. The vaccine has been developed and manufactured by the Serum Institute of India.

The Pneumococcal Polysaccharide Conjugate Vaccine offers protection against 23 types of pneumonia-causing bacteria, which cause a range of infections including meningitis, bacteremia, pneumonia and blood infections.

Serum Institute conducted Phase I, Phase II and Phase III clinical trials of the Pneumococcal Polysaccharide Conjugate Vaccine in India and was successful. They also undertook clinical trials in the West African nation of The Gambia, reported PIB.

The first phase of the trial was conducted in 2013 in India with 34 young adults and the second phase was conducted among 114 toddlers aged between 12-15 months, according to The Print. The third phase of the clinical trials for the vaccine was conducted on 448 infants between the age of six to eight weeks old and was completed in October 2019 as per the governments clinical trial registry.

According to a report by The Hindu, around 2,250 infants were part of the trial in the Gambia and the vaccine has been pre-qualified by the World Health Organisation in December 2019.

With inputs from wires

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Invasive Disease And Its Risk Factors

For disease surveillance purposes, detection of S. pneumoniae in a normally sterile site, such as blood, cerebrospinal fluid or pleural fluid, by culture or polymerase chain reaction, is classified as invasive pneumococcal disease. The highest incidence of invasive pneumococcal disease is seen among young children, especially those under two years, and in the elderly.3,4 The major categories of invasive pneumococcal disease are:

  • meningitis, which is associated with the highest case-fatality rate and possible neurological sequelae among survivors
  • bacteraemic pneumonia
  • bacteraemia without focus, the commonest clinical category in young children.
  • Various medical, environmental and lifestyle factors are associated with an increased risk of developing invasive disease . 5,6 Aboriginal and Torres Strait Islander children and adults have a higher rate of invasive pneumococcal disease compared with other Australians.7,8

    The Road To Conjugate Vaccines

    Progress in Introduction of Pneumococcal Conjugate Vaccine ...

    Early versions of pneumococcal vaccines were made from purified polysaccharide capsules, and the literature shows some benefit controlling pneumococcal outbreaks among miners in South Africa and military recruits during World War II in the US . The first pneumococcal vaccine recommended for use among adults in the US was made from polysaccharides of 14 pneumococcal serotypes. In 1983, the recommendation was updated to include vaccines made from 23 serotypes, a product still in use for high-risk groups among persons 2 years and older. Pneumococcal vaccines of this design were never recommended for children < 2 years of age, however, because polysaccharide antigens do not induce a robust immune response in infants and toddlers.

    A vaccine made from attaching polysaccharide from Hib to a carrier protein was introduced to the market in 1987. This vaccine was highly effective at preventing Hib meningitis, even in infants, and provided the design inspiration for future PCVs. In contrast to the T-cellindependent, mostly B-cell immune response induced by pure polysaccharide vaccines, attaching polysaccharide to a carrier protein creates vaccines that induce T-celldependent immune responses, which are typically robust even in young infants and can be boosted with subsequent doses .

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    The Impact Of Pneumococcal Vaccination In Australia

    In January 2005, Australia implemented universal vaccination of all young children with the 7-valent conjugate vaccine, and of adults aged 65 years and over with the 23-valent polysaccharide vaccine. Before then, there were publicly-funded pneumococcal vaccination programs for Australians with increased risks of pneumococcal disease3 .

    Following universal vaccination, the overall incidence rate of invasive pneumococcal disease decreased by 75% among non-indigenous children under two from 78 per 100 000 in 200204 to 19.5 per 100 000 in 2007. Invasive disease caused by the seven vaccine serotypes declined by 97%, from 60.9 per 100 000 to 2.1 per 100 000.3,9 Rates of hospitalisation due to pneumonia have decreased by 38% in children under two years.10 Substantial reductions in invasive disease were also observed in older children and adults, the age groups who did not receive the vaccine. The decline was mostly due to a decrease in invasive disease caused by the seven vaccine serotypes . 3,4 This suggests a strong benefit of herd immunity, additional to any direct effect arising from the adult 23-valent vaccine program.

    Serum Institute Has Conducted The Phase 1 2 And 3 Clinical Trials Of The Vaccine In India And African Nation Gambia

    Serum Institute has conducted the phase 1, 2 and 3 clinical trials of the vaccine.

    New Delhi:

    The first indigenous vaccine against pneumonia, developed by the Serum Institute of India , is slated to be launched by Union Health Minister Harsh Vardhan and made available in the domestic market early next week, official sources said.

    According to the sources, the vaccine will be much more affordable than the existing ones manufactured by two foreign companies.India”s drug regulator in July had granted market approval for the Pneumococcal Polysaccharide Conjugate vaccine, after reviewing the phase 1, 2 and 3 clinical trial data submitted by the Pune-based firm.

    This vaccine is used for active immunisation against invasive disease and pneumonia caused by “Streptococcus pneumonia” in infants, the health ministry had said earlier.

    Serum Institute has conducted the phase 1, 2 and 3 clinical trials of the vaccine in India and African nation Gambia.

    “This is the first indigenously developed vaccine in the field of pneumonia,” an official source said.

    The vaccine will be much more affordable than the existing ones produced by Pfizer and GlaxoSmithKline , the sources said.

    “It has always been our endeavour to fulfil our prime minister’s dream for ”vocal for local” and ”Making in India” for the world.

    The country is currently dependent on imported PCV of foreign manufacturers at a very high price, the source said.

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    Who: 3rd Pneumonia Vax At Parity With Other Vaccines

    The World Health Organization , in a recent study, declared that a third pneumococcal vaccine developed by the Serum Institute of India is at parity with two other vaccines being offered to address child pneumonia, the number one killer disease among kids.

    At present, two PCVs, both coming from global vaccine manufacturers, are being offered to address child pneumonia Pfizers Prevnar or PCV 13 and GlaxoSmithKline Synflorix or PCV 10.

    The third PCV, Serum Institutes Pneumosil, has been declared by a 2021 WHO study as non-inferior to both Prevnar and Synflorix.

    According to UNICEF, one child dies globally every 39 seconds because of pneumonia.

    The situation has been exacerbated by the global attention on COVID-19, which has somehow taken attention away from pneumonia and other top diseases that could have otherwise been prevented by vaccination.

    In the Philippines, the Pediatric Infectious Disease Society of the Philippines in its December 2021 journal cited pneumonia as the third leading cause of death among children 5 years old and below, accounting for 14 percent in child mortality.

    In its 2021 study on prequalifying PCVs for childhood immunization programs, the WHO said the 10-valent has the same substantial impact against pneumonia, vaccine-type , invasive pneumococcal disease , and nasopharyngeal carriage in a variety of settings, when compared to the earlier prequalified 13-valent vaccine.

    Pneumococcal Disease In Adults

    WHO approves new vaccine to protect children against pneumonia

    Pneumococcal pneumonia is the most common clinical presentation of pneumococcal disease among adults. The incubation period of pneumococcal pneumonia is short, about 1 to 3 days. Symptoms generally include an abrupt onset of fever and chills or a single rigor. Repeated shaking chills are uncommon. Other common symptoms include pleuritic chest pain, cough productive of mucopurulent, rusty sputum, dyspnea, tachypnea, hypoxia, tachycardia, malaise, and weakness. Nausea, vomiting, and headaches occur less frequently. Complications of pneumococcal pneumonia include bacteremia, empyema , pericarditis , and endobronchial obstruction, with atelectasis and lung abscess formation.

    Pneumococcal Disease in Adults

  • Symptoms: Headache, lethargy, vomiting, irritability, fever, nuchal rigidity, cranial nerve signs, seizures, coma
  • 14% case fatality ratio
  • Pneumococcal bacteremia can occur with or without pneumonia and lead to arthritis, meningitis, and endocarditis. The case fatality ratio of pneumonia with bacteremia is around 10%. More than 5,000 cases of pneumococcal bacteremia without pneumonia occur each year. The overall case fatality ratio for bacteremia is about 12%. Patients with asplenia who develop bacteremia may experience a fulminant clinical course.

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    Whats The Difference Between Pcv13 And Ppsv23

    PCV13
    helps protect you against 13 different strains of pneumococcal bacteriahelps protect you against 23 different strains of pneumococcal bacteria
    usually given four separate times to children under twogenerally given once to anyone over 64
    generally given only once to adults older than 64 or adults older than 19 if they have an immune conditiongiven to anyone over 19 who regularly smokes nicotine products like cigarettes or cigars
    • Both vaccines help prevent pneumococcal complications like bacteremia and meningitis.
    • Youll need more than one pneumonia shot during your lifetime. A 2016 study found that, if youre over 64, receiving both the PCV13 shot and the PPSV23 shot provide the best protection against all the strains of bacteria that cause pneumonia.
    • Dont get the shots too close together. Youll need to wait about a year in between each shot.
    • Check with your doctor to make sure youre not allergic to any of the ingredients used to make these vaccines before getting either shot.
    • a vaccine made with diphtheria toxoid
    • another version of the shot called PCV7
    • any previous injections of a pneumonia shot
    • are allergic to any ingredients in the shot
    • have had severe allergies to a PPSV23 shot in the past
    • are very sick

    A Look At Each Vaccine: Pneumococcal Vaccine

    Much like Haemophilus influenzae type b , pneumococcal bacteria affect the most defenseless of the population . The diseases caused by pneumococcus include meningitis , bloodstream infections and pneumonia . The pneumococcal vaccine was first introduced for use in all infants in the United States in 2000. Before the vaccine, every year pneumococcus caused about 700 cases of meningitis, 17,000 cases of bloodstream infections, 200 deaths and 5 million ear infections in children.

    Infants and young children are at greatest risk of serious infection because they are unable to develop immunity to the sugar that coats the bacteria, something that older children can do when they are more than 2 years of age.

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    Pneumococcal Disease In Children

  • S. pneumoniae leading cause of bacterial meningitis among children younger than age 5 years
  • Pneumococci common cause of acute otitis media
  • Bacteremia without a known site of infection is the most common invasive clinical presentation of pneumococcal infection among children age 2 years or younger, accounting for approximately 40% of invasive disease in this age group. Bacteremic pneumonia accounts for 25% to 30% of invasive pneumococcal disease among children age 2 years or younger. With the decline of invasive Haemophilus influenzae type b disease, S. pneumoniae has become the leading cause of bacterial meningitis among children younger than age 5 years in the United States. Before routine use of pneumococcal conjugate vaccine, children younger than 1 year had the highest rates of pneumococcal meningitis, approximately 10 cases per 100,000 population.

    Pneumococci are a common cause of acute otitis media and are detected in 24% to 31% of middle ear aspirates. By age 12 months, more than 60% of children have had at least one episode of acute otitis media. Middle ear infections are a leading reason for pediatric office visits in the United States, resulting in more than 10 million visits annually. Complications of pneumococcal otitis media may include mastoiditis and meningitis.

    Extended Pneumococcal Immunisation For High

    Merck

    As part of the extended immunisation programme for high-risk groups, PCV13 and 23PPV are funded for eligible individuals, as shown in Table 16.3, Table 16.4 and Table 16.5. Because the recommended schedule depends on the age of the individual at diagnosis, the tables have been organised into age groups .

    The PCV13 and 23PPV funding restrictions are as follows. See Table 16.3, Table 16.4 and Table 16.5 for the eligible conditions and dosing requirements.

    PCV13

    All high-risk infants are recommended to receive at least three doses of a PCV vaccine, with at least one dose after 12 months of age. Change from PCV10 to PCV13 as soon as the infant is diagnosed as being at high risk.

    • Two doses of PCV13 are funded for high-risk children aged from 12 months and under 18 years who have previously received two or three doses of PCV10.
    • Up to four doses of PCV13 are funded for vaccination or re-vaccination of high-risk children aged under 5 years.
    • Up to four doses of PCV13 are funded for vaccination or re-vaccination of eligible individuals aged 5 years and older.

    23PPV

    1 dose of PCV13.b

    23PPV

    Give a maximum of 3 doses of 23PPV in a lifetime, a minimum of 5 years apart. The first 23PPV dose is given at least 8 weeks after PCV13, the 2nd a minimum of 5 years later, and the 3rd dose at age 65 years.

  • PCV13 is funded pre- or post-HSCT or chemotherapy. 23PPV is only funded post-HSCT or chemotherapy.
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    Children At High Risk Of Ipd

    Infants at high risk of IPD due to an underlying medical condition should receive Pneu-C-13 vaccine in a 4 dose schedule at 2 months, 4 months and 6 months followed by a dose at 12 to 15 months of age. Table 3 summarizes the recommended schedules for Pneu-C-13 vaccine for infants and children at high risk of IPD due to an underlying medical condition by pneumococcal conjugate vaccination history.

    In addition to Pneu-C-13 vaccine, children at high risk of IPD due to an underlying medical condition should receive 1 dose of Pneu-P-23 vaccine at 24 months of age, at least 8 weeks after Pneu-C-13 vaccine. If an older child or adolescent at high risk of IPD due to an underlying medical condition has not previously received Pneu-P-23 vaccine, 1 dose of Pneu-P-23 vaccine should be administered, at least 8 weeks after Pneu-C-13 vaccine. Children and adolescents at highest risk of IPD should receive 1 booster dose of Pneu-P-23 vaccine refer to Booster doses and re-immunization. Refer to Immunocompromised persons for information about immunization of HSCT recipients.

    Table 3: Recommended Schedules for Pneu-C-13 Vaccine for Children 2 months to less than 18 years of age, by Pneumococcal Conjugate Vaccination History

    Age at presentation for immunizationNumber of doses of Pneu-C-7, Pneu-C-10 or Pneu-C-13 previously received

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    • Pneumosil was found to be safe and effective in preventing Pneumonia disease during the clinical trials
    • Harsh Vardhan said that Pneumonia is the single-largest infectious cause of death among children under five years, worldwide

    Harsh Vardhan, Union health minister, today launched Pneumosil, India’s first Pneumococcal Conjugate Vaccine , developed by Serum Institute of India in collaboration with the Bill and Melinda Gates Foundation.

    Speaking at the event, Harsh Vardhan said vaccines from Serum Institute are used in 170 countries and emphasised that the company has developed this vaccine during the Coronavirus pandemic and also got the government’s approval. He also said this vaccine development falls in line with Aatmanirbhar Bharat, the prime minister’s vision.

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    He also acknowledged the efforts made by the Ministry of Health and Family Welfare in this development making India self-reliant in PCV. “Pneumosil has been extensively evaluated in 5 randomized controlled clinical trials and has demonstrated comparable safety and immunogenicity against licensed pneumococcal vaccines across diverse populations of India and Africa,” Harsh Vardhan said.

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